Risk factors for early postoperative hypertension after transcatheter aortic valve implantation in patients with severe aortic stenosis: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHANG Jigao ¹ ,  ZHANG Peide ¹ , WANG Xu ² , FENG Xiang ² , LI Xuanshu ² , ZHANG Yanbo ¹ , WANG Wei ²

1. Department of Cardiac Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding?author：

ZHANG Peide, Email: 100peter@163.com

Keywords：

Transcatheter aortic valve implantation; severe aortic stenosis; postoperative hypertension; risk factors

DOI：

10.7507/1007-4848.202404025

Video：

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Objective To explore the risk factors and potential mechanisms of hypertension events on the same day after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. Methods Clinical data of patients who underwent TAVI for severe aortic stenosis at Department of Structural Heart Disease, Fuwai Hospital from December 2023 to February 2024 were retrospectively collected. According to the peak systolic blood pressure on the same day after surgery, patients were divided into a hypertension group (≥140 mm Hg) and a normal blood pressure group (<140 mm Hg). Logistic regression model was used to analyze the risk factors for hypertension on the same day after TAVI. Results A total of 54 patients after TAVI were included, with 41 patients in the hypertension group, including 18 males and 23 females, with an average age of (72.83±6.78) years; 13 patients in the normal blood pressure group, including 9 males and 4 females, with an average age of (70.00±7.57) years. Univariate analysis found that there were statistical differences in interventricular septal thickness [(13.71±1.98) mm vs. (12.23±1.59) mm, P=0.018], preoperative left ventricular ejection fraction (LVEF)>55% [33 (80.5%) vs. 6 (46.2%), P=0.040], and postoperative same-day LVEF>55% [33 (80.5%) vs. 4 (30.8%), P=0.003]. Multivariate logistic regression analysis found that postoperative same-day LVEF>55% [OR=10.173, 95%CI (1.044, 99.115), P=0.046] was an independent risk factor for hypertension on the same day after TAVI. Conclusion Myocardial contractility mainly participates in the occurrence of hypertension on the same day after TAVI. This study can not only improve our understanding of early hemodynamic changes after TAVI, but also provide a basis for the formulation of early hypertension treatment plans after TAVI to improve the short- and long-term prognosis of patients.

Citation： SHANG Jigao, ZHANG Peide, WANG Xu, FENG Xiang, LI Xuanshu, ZHANG Yanbo, WANG Wei. Risk factors for early postoperative hypertension after transcatheter aortic valve implantation in patients with severe aortic stenosis: A retrospective cohort study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(12): 1813-1819. doi: 10.7507/1007-4848.202404025 Copy

1.	Mancusi C, de Simone G, Brguljan Hitij J, et al. Management of patients with combined arterial hypertension and aortic valve stenosis: A consensus document from the Council on Hypertension and Council on Valvular Heart Disease of the European Society of Cardiology, the European Association of Cardiovascular Imaging (EACVI), and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J Cardiovasc Pharmacother, 2021, 7(3): 242-250.
2.	Jin XY, Petrou M, Hu JT, et al. Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement. Front Med, 2021, 15(3): 416-437.
3.	Grinberg T, Aviv Y, Vaturi M, et al. Noninvasive hemodynamic evaluation following TAVI for severe aortic stenosis. J Am Heart Assoc, 2023, 12(7): e028479.
4.	中國老年醫學學會高血壓分會, 北京高血壓防治協會, 國家老年疾病臨床醫學研究中心 (中國人民解放軍總醫院, 首都醫科大學宣武醫院) . 中國老年高血壓管理指南2023. 中華高血壓雜志, 2023, 31(6): 508-538.Hypertension Branch of the Chinese Geriatrics Society, Beijing Association for the Prevention and Treatment of Hypertension, National Clinical Research Center for Geriatric Diseases (Chinese People's Liberation Army General Hospital, Xuanwu Hospital of Capital Medical University). Chinese guidelines for the management of hypertension in the elderly 2023. Chin J Hypertens, 2023, 31(6): 508-538.
5.	中華醫學會心血管病學分會心血管影像學組, 北京醫學會心血管病學會影像學組. 中國成人心臟瓣膜病超聲心動圖規范化檢查專家共識. 中國循環雜志, 2021, 36(2): 109-125.Division of Cardiovascular Imaging, Chinese Society of Cardiology, Chinese Medical Association, Imaging Group, Cardiovascular Department, Beijing Medical Association. Expert consensus for standard assessment by echocardiography in chinese adults with valvular heart disease. Chin Circ J, 2021, 36(2): 109-125.
6.	Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 2018, 71(6): e13-e115.
7.	Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet, 2016, 387(10022): 957-967.
8.	Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: A systematic review and network meta-analysis. JAMA Cardiol, 2017, 2(7): 775-781.
9.	Inohara T, Manandhar P, Kosinski AS, et al. Association of renin-angiotensin inhibitor treatment with mortality and heart failure readmission in patients with transcatheter aortic valve replacement. JAMA, 2018, 320(21): 2231-2241.
10.	Ochiai T, Saito S, Yamanaka F, et al. Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation. Heart, 2018, 104(8): 644-651.
11.	Lindman BR, Goel K, Bermejo J, et al. Lower blood pressure after transcatheter or surgical aortic valve replacement is associated with increased mortality. J Am Heart Assoc, 2019, 8(21): e014020.
12.	Endo N, Otsuki H, Domoto S, et al. Haemodynamic collapse immediately after transcatheter aortic valve implantation due to dynamic intraventricular gradient: A case report and review of the literature. Eur Heart J Case Rep, 2021, 5(2): ytaa565.
13.	Dumonteil N, Vaccaro A, Despas F, et al. Transcatheter aortic valve implantation reduces sympathetic activity and normalizes arterial spontaneous baroreflex in patients with aortic stenosis. JACC Cardiovasc Interv, 2013, 6(11): 1195-1202.
14.	Julario R, Mulia EPB, Rachmi DA, et al. Evaluation of heart rate variability using 24-hour Holter electrocardiography in hypertensive patients. J Arrhythm, 2020, 37(1): 157-164.
15.	Tomiyama H, Shiina K. State of the art review: Brachial-ankle PWV. J Atheroscler Thromb, 2020, 27(7): 621-636.

1. Mancusi C, de Simone G, Brguljan Hitij J, et al. Management of patients with combined arterial hypertension and aortic valve stenosis: A consensus document from the Council on Hypertension and Council on Valvular Heart Disease of the European Society of Cardiology, the European Association of Cardiovascular Imaging (EACVI), and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J Cardiovasc Pharmacother, 2021, 7(3): 242-250.
2. Jin XY, Petrou M, Hu JT, et al. Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement. Front Med, 2021, 15(3): 416-437.
3. Grinberg T, Aviv Y, Vaturi M, et al. Noninvasive hemodynamic evaluation following TAVI for severe aortic stenosis. J Am Heart Assoc, 2023, 12(7): e028479.
4. 中國老年醫學學會高血壓分會, 北京高血壓防治協會, 國家老年疾病臨床醫學研究中心 (中國人民解放軍總醫院, 首都醫科大學宣武醫院) . 中國老年高血壓管理指南2023. 中華高血壓雜志, 2023, 31(6): 508-538.Hypertension Branch of the Chinese Geriatrics Society, Beijing Association for the Prevention and Treatment of Hypertension, National Clinical Research Center for Geriatric Diseases (Chinese People's Liberation Army General Hospital, Xuanwu Hospital of Capital Medical University). Chinese guidelines for the management of hypertension in the elderly 2023. Chin J Hypertens, 2023, 31(6): 508-538.
5. 中華醫學會心血管病學分會心血管影像學組, 北京醫學會心血管病學會影像學組. 中國成人心臟瓣膜病超聲心動圖規范化檢查專家共識. 中國循環雜志, 2021, 36(2): 109-125.Division of Cardiovascular Imaging, Chinese Society of Cardiology, Chinese Medical Association, Imaging Group, Cardiovascular Department, Beijing Medical Association. Expert consensus for standard assessment by echocardiography in chinese adults with valvular heart disease. Chin Circ J, 2021, 36(2): 109-125.
6. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 2018, 71(6): e13-e115.
7. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet, 2016, 387(10022): 957-967.
8. Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: A systematic review and network meta-analysis. JAMA Cardiol, 2017, 2(7): 775-781.
9. Inohara T, Manandhar P, Kosinski AS, et al. Association of renin-angiotensin inhibitor treatment with mortality and heart failure readmission in patients with transcatheter aortic valve replacement. JAMA, 2018, 320(21): 2231-2241.
10. Ochiai T, Saito S, Yamanaka F, et al. Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation. Heart, 2018, 104(8): 644-651.
11. Lindman BR, Goel K, Bermejo J, et al. Lower blood pressure after transcatheter or surgical aortic valve replacement is associated with increased mortality. J Am Heart Assoc, 2019, 8(21): e014020.
12. Endo N, Otsuki H, Domoto S, et al. Haemodynamic collapse immediately after transcatheter aortic valve implantation due to dynamic intraventricular gradient: A case report and review of the literature. Eur Heart J Case Rep, 2021, 5(2): ytaa565.
13. Dumonteil N, Vaccaro A, Despas F, et al. Transcatheter aortic valve implantation reduces sympathetic activity and normalizes arterial spontaneous baroreflex in patients with aortic stenosis. JACC Cardiovasc Interv, 2013, 6(11): 1195-1202.
14. Julario R, Mulia EPB, Rachmi DA, et al. Evaluation of heart rate variability using 24-hour Holter electrocardiography in hypertensive patients. J Arrhythm, 2020, 37(1): 157-164.
15. Tomiyama H, Shiina K. State of the art review: Brachial-ankle PWV. J Atheroscler Thromb, 2020, 27(7): 621-636.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for early postoperative hypertension after transcatheter aortic valve implantation in patients with severe aortic stenosis: A retrospective cohort study in a single center

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